We are family carers, people who use, or have used, mental health services in Haringey, and local residents. This charter is also supported by mental health workers and local voluntary sector groups.

We have had enough of putting up with inadequate and diminishing health and social care services for people living with severe, long-term mental illness – which results in some of the most vulnerable in our community being put at unacceptable (sometimes life-threatening) risk. Service-users often experience difficulties and delays in getting help, and a lack of joined-up services. Front-line NHS mental health workers are doing their best, but are struggling to provide good-quality services, because of over-high caseloads, and lack of hospital beds, as well as poor systems and processes. The local situation reflects the crisis in NHS mental health services nationally.

We call on the Haringey Clinical Commissioning Group (CCG), which funds local NHS services, and on Barnet Enfield & Haringey Mental Health Trust (BEH-MHT) and Haringey Council (LBH) to support this Charter. We want the Trust, the CCG and LBH to draw up an action plan to implement the changes that are needed, described below, and we call on the Haringey Adults & Health Scrutiny Committee and Healthwatch to hold these organisations to account in implementing urgently needed improvements in our NHS mental health services. We want:

Effective ‘early intervention’ services - to provide the right help at the right time

Swift routes, when needed, to hospital wards and recovery houses, with enough beds available

A transformation in the quality of the Crisis Response Home Treatment (CRHT) service

Service-users and carers views to be listened to – a genuine ‘Open Dialogue’

What happens now

What we need

1. Community mental health teams are very overstretched

The eligibility thresholds for getting help from the Early Intervention Service (EIS) and Support & Recovery Teams are set so high that people have to become extremely unwell before they get help that is often ‘too little too late’. The mental health teams are under huge pressure, with Care Co-ordinators having such large caseloads that they often don’t have sufficient capacity to provide regular or extra support quickly for people in the early stages of crisis to prevent their mental health worsening. People are also being discharged from community MH teams before they feel ready.

We want effective early intervention

We need community mental health teams and Care Co-ordinators with flexibility and enough capacity to respond swiftly to support people living with severe mental illness, at the early stages of becoming unwell, before it becomes acute; offering additional home visits and other forms of support, including therapy and recovery programmes that the person feels might help them, ideally avoiding the need for hospitalisation. Statutory mental health services need to collaborate better with GPs, the voluntary sector and local authority to improve early intervention & support services.

2. There is a desperate shortage of acute psychiatric beds

The acute psychiatric wards in St Ann’s, Chase Farm, Barnet and Edgware hospitals are typically operating at well over 100% occupancy. This means that people who need a bed are either having to be left unsafe at home, placed in private sector beds, sometimes far away from their support networks, or discharged too early, placing further stress on patients and families.

We want enough hospital beds available locally

We need enough acute mental health beds available so that people who need to be admitted to hospital can be sure of getting a local hospital bed when they need it. Wards should be operating at no more than the recommended 85% capacity. Decisions about how many beds to commission must be based on a genuine objective assessment of local need, with beds close to support networks.

3. The crisis response service is not fit for purpose

The emergency response service for people in mental health crisis - the Crisis Resolution & Home Treatment Team (CRHTT) is stretched to the limit, and staff say they are ‘burnt out’. The team prioritises above all its role as a ‘gatekeeper’ – restricting access to the over-full psychiatric hospital wards, sometimes inappropriately leaving people at home, placing too great a burden of managing risk onto patients and family carers.

Many service users and families feel that the ‘home treatment’ aspect of the CRHT service is ineffective and unhelpful, due to the total lack of consistency of care (ie. with different staff visiting every day), and the staff’s lack of time to be able to do much more than simply administer medication.

We want an effective and accountable emergency crisis response & home treatment service

We need a complete transformation in the quality of the service provided by the CRHTT. The service should adhere to the NICE guidelines and the ‘Crisis Care Concordat’ in terms of emergency response times: ie. to guarantee to assess clients face-to-face when needed within four hours of receiving the referral. We need a CRHT service that is transparent and accountable about its performance against measurable targets on response times. We need a home treatment service that offers much greater continuity of care, and high-quality therapeutic support, to help people get through a crisis, without having to go into hospital, where this is safe and possible.

4. Routes to admission into hospital and recovery houses for people in acute mental health crisis are very unclear, confusing and convoluted.

There are lots of ‘barriers’ to get through with often unacceptable delays in getting admitted to hospital, or people not getting admitted at all, increasing the risk of harm. Often the only way to get a bed is to be sectioned under the Mental Health Act. This is unacceptable.

We want clear information on how to get admitted to hospital in an emergency

We need BEH-MHT to publish a clear guide that explains step-by-step the process of how to get an urgent admission to hospital for people in acute mental health crisis: ie. who they should telephone, where to go, what they have a right to expect in terms of response times from emergency services (crisis teams and A&E), and what to do if the services do not work as they should.

5. There is a severe lack of suitable housing for vulnerable people

People are stuck, ‘blocking’ mental health beds in wards and recovery houses, unable to be discharged when they are ready to be, because of the lack of suitable supported (and where necessary adapted) accommodation. Poor housing and lack of choice is impeding recovery of many with severe mental health. Short-term supported accommodation creates instability for service-users who have to move frequently.

We want adequate housing for people with severe mental health conditions

We need more affordable good-quality housing, so that all those in our community who are living with severe mental health conditions are able to live in safe and habitable homes, near to their support networks, supporting their recovery. We need a range of different types of high quality housing – from 24-hour supported accommodation, through a variety of recovery houses, sheltered housing, individual flats, and wheelchair-accessible homes.

6. Carers feel they are not listened to

Carers feel that their views are often not listened to or their needs taken into account by mental health professionals. Too much burden is placed on family carers to fill the gaps of inadequate overstretched mental health services, placing service users and carers at unacceptable risk.

We want an ‘Open Dialogue’ approach.

We need all NHS mental health services to embrace the principles of the ‘Open Dialogue’ approach genuinely working together with service users and carers, listening and giving us an equal voice (and providing appropriate responses to those with particular needs, for example Autism, Asperger’s, or at risk of self-harm or suicide).